Week 9 - Neurological Examination Flashcards
When should a neurological exam be performed? (2)
If a positive myotome test occurs during an upper or lower quarter scan.
If patient reports a loss of feeling, numbness, or feeling during the history.
Based on the Guide to Physical Therapist Practice, what Test and Measurements are included with a neurological exam? (5)
- Cognition
- Cranial Nerve Integrity
- Pain
- Reflex Integrity
- Sensory Integrity
What are the various components of a nerological examination we can perform based on a patients history or results from a scanning exam? (6)
- Pain
- Sensory Examination
- Reflex Examination
- Deep Tendon Reflex
- Cutaneous Reflexes - Motor Screen - Coordination
- Cranial Nerve Integrity
- Cognition (Mini-Mental State Exam)
If a patient reports pain during their history, what can be used?
a Visual Analog Scale (VAS) [100mm length line from 0 or None to Unberable or 100]
T/F: The VAS can be used to document pain at multiple times?
True
When can a patient document their pain level on a VAS?
Worst pain, least pain, pain level after activity vs before
What tool can be used to document a patient’s pain patter?
A Body Chart to graph/document location of PAIN and other sensory disturbances.
T/F: A Body Chart is done in discussion with the patient?
True
On a body chart, what symbol represents Stabbing pain?
///
On a body chart, what symbol represents Pins and Needles pain?
000
On a body chart, what symbol represents Burning pain?
XXX
On a body chart, what symbol represents Numbness pain?
===
What is a sensory examination guided by?
patient’s reporting “loss of feeling”, “numbness”, pins and needles”, “tingling”, or other subjective feelings of the patients.
How does a sensory examination usually begin?
with affected side, using unaffected side for comparison
before choosing a modality test, what might we have to conduct to confirm more specific locations and type of sensory loss?
Scanning Exam of Dermatomes
What do clinitians use to asses a potential sensory loss?
Dermatomal patterns
Define Dermatome
Area of the skin predominantly innervated by a single spinal nerve
In additional to dermatomes, a clinicion may want to if a sensory loss has occured over an area of the skin that is innervated by ___
a specific peripheral nerve (peripheral nerve fields)
How often and when is an entire body sensory examination performed?
rarely, a spinal cord injury would necessitate an entire body assessment of sensation
If a patient does not report a sensory loss, IF a motor loss is observed in a peripheral nerve pattern, what should be done?
a sensory examination
Sensory deficits are detected by
comparing the sensation between identical regions on two sides of the body
OR between proximal and distal regions of the same side of the body
What constitutes as abnormalities in sensation?
Differences in the patient’s ability to perceive a sensory stimulus between body regions
OR a patients failure to detect a stimulus when applied
Procedure
- The patient should be positioned so that all test areas are accessible
- The testing procedure should be explained to the patient before beginning the examination.
- They need to know what you are going to do and how they should respond to the test.
- Always demonstrate the sensory modality to be tested on an area of the patient’s skin with intact sensation, if possible - The patient’s vision must be blocked during the sensory test
- Exam should start in areas of impaired or absent sensation and progress to areas of normal sensation
- Area of the patient’s skin where sensation is normal should be used as our comparison
- May be opposite side of body OR a more proximal part of body (spinal cord injury) - Sensory deficits should be carefully noted by examiner.
- Instruments used to test sharp-dull sensation should only be used on ONE patient
- Either should be disposed of in sharps container or sterilized
What are the three most common modalities that we use to assess sensation?
Sharp-Dull
Light Touch
Temperature
What is used to assess Sharp-Dull sensation?
clean, unused safety pin
What is used to assess Light Touch?
Wisp of Cotton or Finger Tips
What is used to assess Temperature?
Assess using glass test tubes with crushed ice/water and hot tap water (outside of test tubes should be kept dry
UQ Scan: C4 =
Lateral Acromium
UQ Scan: C5 =
Mid Deltoid
UQ Scan: C6 =
Radial border of forearm/thumb
UQ Scan: C7 =
Distal middle finger
UQ Scan: C8 =
Ulnar border of forearm/5th digit
UQ Scan: T1 =
Medial border of arm
LQ Scan: L1 =
Inguinal Area
LQ Scan: L2 =
Anterior mid-thigh
LQ Scan: L3 =
Medial Knee
LQ Scan: L4 =
Medial Malleolus
LQ Scan: L5 =
Distal medial dorsum of foot
LQ Scan: S1 =
Lateral border of foot
LQ Scan: S2 =
Medial / Posterior Calcaneus
What is used to assess vibration?
128-Hz tuning fork
T/F: Apply both non-vibrating and vibrating fork to patient
true
Do you want to start proximally and move distally, or start distally and move proximally.
Start distally and move proximally
What are the landmarks for testing vibration on the UE?
- Distal Phalanx Finger
- Ulnar Styloid Process
- Olecranon Process
- Acromion Process
- C7 Cervical Spinous Process
What are the landmarks for testing vibration on the LE?
- Distal Phalax of Great Toe
- Medial Malleolus
- Patella
- ASIS
- Lumbar Spinous Process
